<!-- contact-history-add -->

<link rel="stylesheet" type="text/css" href="css/bootstrap.css" />

<div id="dialog-fade" id="sales-profile" tabindex="-1" role="dialog" style="width: 600px;">
	<div id="dialog-bg" style="height: 380px;">
		<div id="modal-header">Contact History Add</div>
		<div id="modal-body"
			style=" width: 560px; border-top: 1px solid #B9B9B9;">
			<div class="modal-content" style="height: 280px; width: 580px;">

				<form name="contactHistoryAdd" required>
					<div style="width: 100%; overflow: auto;">
						<div class="">
							<div>
								<table width="100%">
									<tr>
										<td
											style="text-align: right; font-size: 13px; padding: 0px 10px;">
											<span class="requiredFieldIndicator">*<b>required</b></span>
										</td>
									</tr>
									<tr>
										<td style="padding: 6px;"><span class="fieldLabel">Contact
												Date</span><br /> <span class="">01-11-15</span></td>
									</tr>
									<tr>
										<td style="padding: 6px;"><span class="fieldLabel">Customer</span><br />
											<span class="">(ECI-123455678)</span></td>
									</tr>
									<tr>
										<td style="padding: 6px;"><label><span
												class="fieldLabel">Description</span></label> <span
											class="requiredFieldIndicator">*</span><br /> <select
											name="" required><option value="">select....</option>
												<option value=""></option></select></td>
									</tr>
									<tr>
										<td style="padding: 6px;"><span class="fieldLabel">Notes</span>
											<span class="requiredFieldIndicator">*</span><br /> <textarea
												name="notes" required data-trim="false" maxlength="200"
												cols="50" rows="4" overflow="auto"></textarea><br /> <span>{text.length}
												out of 200 characters used.</span></td>
									</tr>
									<tr>
										<td style="padding: 6px;"><span class="fieldLabel">Created
												By</span><br /> <span class=""></span></td>
									</tr>
								</table>
							</div>
						</div>
					</div>
				</form>
			</div>

		</div>
		<div id="dialog-buttons" style="text-align: center;">
				<button type="button" class="medium green button" onclick="submit">Submit</button>
				<button type="button" class="button secondary" data-dismiss="modal">Cancel</button>
		</div>
	</div>
</div>
